WAR IN THE GULF: The Medics; Trek Across the Desert May Hinder Lifesaving

By PHILIP J. HILTS, Special to The New York Times

Published: February 1, 1991

WASHINGTON, Jan. 31—
The front-line American medical system in the Persian Gulf is set up to handle 15,000 wounded soldiers a day, even if 3,000 of them need emergency surgery, officials say.

The officials would not disclose estimates of possible casualties in an extensive ground war. But analysts who have studied casualty rates in other wars, including Israeli ground combat in 1967, 1973 and 1982, say that this capacity should be adequate for even the high-casualty scenarios for the war.

With American ground forces suffering casualties on Wednesday in the first sustained ground combat of the war, the military is likely to focus new attention on the strength and preparedness of the medical system.

Brig. Gen. Ronald R. Blanck, director of professional services in the Army Surgeon General's office, said that "well over 20,000" doctors, nurses, technicians and other medical personnel were now in the Persian Gulf. 3 Times More Medical Workers

He said he could not give a more precise estimate, but recently he remarked that there were three times as many medical personnel in the gulf as there were in Vietnam at the peak of the fighting there, when the medical staff numbered about 9,000.

Beyond first aid on the battlefield, there are more than 30 mobile hospital units near the front lines in the gulf. Backing them up are several larger hospitals ranging in size from 500 beds to the two medical ships with 1,000 beds each at anchor in the gulf.

But in this war, getting the wounded to hospitals could be a major problem.

In Vietnam, the wounded could often be flown straight from the battlefield to the surgical units by helicopter for lifesaving care. But planners who designed the medical installations for the gulf war assume that if hundreds of thousands of soldiers fight in the great expanses of the desert, where enemy infantry may carry weapons to knock down helicopters, they will have rely on stretchers and field ambulances to move the wounded. Delays in Evacuation

Military officials said the first American to receive a Purple Heart for suffering wounds in the gulf war took two and a half hours to reach the hospital from the battlefield, even without the pressure of combat, because of transportation problems.

Possible delays in evacuation are particularly worrisome because military experts attribute some of the increase in the survival rate among wounded soldiers in recent wars to speedier treatment.

In World War I, an average of 18 to 24 hours passed between the time a man was wounded and his surgical treatment in a hospital. In World War II, it was 6 to 16 hours.

In the Vietnam War, with its close quarters and heavy use of helicopters, the time between hurt and help averaged two hours but could be as little as 30 minutes. With the improved speed came a reduction in deaths among the wounded, from 8.5 percent in World War I to 1.7 percent in Vietnam.

In the Persian Gulf, "many of the wounded may have to be carried first by litter from the field, then by truck back to a station where helicopters may evacuate them to a surgical hospital," General Blanck said. "It could take hours in some situations." The Platoon Lifesaver

Because of potential delays, the military now gives all soldiers training in a few emergency medical techniques like clearing respiratory blockage. "A wounded soldier's survival may depend on his buddy's ability to initiate lifesaving care on the battlefield," wrote Lieut. Col. James A. Martin, commander of the Army Medical Research Unit. "Each soldier should possess the skill to clear an airway, control bleeding and start an intravenous fluid line to control shock."

Foot soldiers do not have that full training, but in many platoons, General Blanck said, one soldier has been trained and designated the lifesaver.

"We did not have this in Vietnam," he said, "and it may really be needed in the kind of warfare we may have in the gulf."

Other changes since the Vietnam War include new vaccines and treatments, including one for Hepatitis A and one to prevent septic shock from a sudden invasion of certain types of bacteria in people who are most seriously wounded. There are vaccines against local diseases, and one against anthrax to protect troops who may be targets of biological warfare.

Once they reach a hospital, soldiers will benefit from improved techniques to repair torn blood vessels and treat burns. CAT scanners will be available in the larger hospitals of each corps, General Blanck said. Heat Is a Serious Factor

The wounds suffered in troop engagements are expected to be similar to those of other wars of the last two decades, though wounds in this war may be cleaner because there is less bacteria-loaded muck to clog them. Heat may be a serious factor, however, since it can cause heat exhaustion and encourage the growth of bacteria in wounds.

The most serious wounds are those sustained in the abdomen, chest, neck and head. Wounds in the head and neck account for about 15 percent of casualties; in the chest, 7 percent; abdomen, 5 percent, and limbs, 60 percent. In Vietnam, multiple wounds accounted for 20 percent of the casualties.

Most wounds in this war are expected to be caused by bullets and shrapnel. Burns are expected to account for about 10 percent.

Of the wounds that cause death, head and neck injuries cause the largest proportion, 40 percent of all deaths. Chest and abdominal wounds each cause 20 percent, while 15 percent come from multiple wounds. About 8 percent bleed to death from limb wounds. A small fraction of the deaths have multiple causes.